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Ultrasound‐Guided Suture Lateralization in Pediatric Bilateral Vocal Fold Immobility
Author(s) -
Puricelli Michael D.,
Peterson Joseph,
Kanotra Sohit P.
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28553
Subject(s) - medicine , intubation , airway , surgery , ultrasound , radiology
Bilateral true vocal fold immobility (BVFI) is a rare clinical entity but is among the leading differential diagnoses for respiratory distress in neonates. The various etiologies for neonatal BVFI include birth trauma, neurological disorders such as Arnold-Chiari malformation, hydrocephalus, cerebral palsy, hypoxia, cardiac surgery and idiopathic. Patients can be temporized with positive pressure ventilation to pneumatically stent the glottis or intubation may be performed to bypass the obstructive site. Since spontaneous return of function occurs in over 50% to 66% of cases, reversible interventions are favored to provide an adequate airway for ventilation while minimizing adverse effects such as aspiration and dysphonia. Traditionally a tracheostomy was performed, however, due to the morbidity and mortality associated with tracheostomy, alternative treatment options such as endoscopic anterior–posterior cricoid split and suture lateralization have been reported. Suture laterization can either be performed under visualization endolaryngeally requiring a special laterization instrument (which is not approved by the U.S. Food and Drug Administration) or can be performed exolaryngeally. A Lasso technique was devised but accurate prediction of needle trajectory is difficult and multiple approaches can result in tissue injury. The greatest challenge with the transcutaneous lasso technique is precise needle placement. Systemically, ultrasound technology has been applied to improve the accuracy of needle placement, particularly for difficult to identify or palpate regions or when great precision is required. Laryngeal anatomy is readily visualized on ultrasound and the technology is used in some protocols for diagnosing laryngeal pathology. Ultrasound-aided laryngeal intervention, however, is not widely reported in the literature. We describe a method of ultrasound-guided suture laterization which helps in accurate prediction of the needle trajectory minimizing repeated attempts while reducing the operative time.